Frontal plane knee alignment among normal northern Nigerian adults: A radiographic study
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Studies have shown that knee alignment parameters differ among races. However, to our knowledge, radiographic frontal plane knee alignment has not been studied in normal northern Nigerian adults. The objective of this study was therefore to determine the frontal plane knee alignment in normal northern Nigerian adults. This study recruited a total of 59 consented subjects (44 males, 15 females). The entire subjects are without any history of lower extremity deformity. Anteroposterior radiographs of both knees with the patella positioned straight ahead were obtained from each participant while standing in a relaxed bipedal stance and placing equal weight on each limb. Alignment was assessed by measuring the tibiofemoral angle (TFA), distal femoral angle (DFA) and proximal tibial angle (PTA). The angles were measured with the aid of a universal plastic goniometre and a plastic ruler. Descriptive statistics of the alignment parameters, independent and paired t-test were computed. In the male population, the mean (standard deviation) obtained were 179.06 (3.87)o for the TFA, 85.94 (3.03 o for the DFA and 89.27 (3.26)o for the PTA. In the female population, the values were 179.53 (3.38)o for the TFA, 86.40 (2.97)o for the DFA and 89.27 (2.15)o for the PTA. No significant mean difference was observed between genders in all the parameters. The TFA does not show any significant difference between the right and left angle regardless of gender. However, significant mean differences were observed in the DFA and PTA of males and combined population. No significant difference was observed in the DFA and PTA of females. Accordingly, northern Nigerian adults may have varus knee alignment compared to other races. Thus, this pre-existing varus alignment should be taken into consideration during clinical examination, preoperative planning and postoperative evaluations of knee deformities in this population.
Zach L, Kuncicka L, Ruzicka P, Kocich R. Design, analysis and verification of a knee joint oncological prosthesis finite element model. Comput Biol Med. 2014; 54: 53-60. DOI: https://doi.org/10.1016/j.compbiomed.2014.08.021
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. Wolters Kluwer Health; 2013.
Victor J. Rotational alignment of the distal femur: a literature review. Orthopaedics & traumatology, surgery & research : OTSR. 2009; 95: 365-72. DOI: https://doi.org/10.1016/j.otsr.2009.04.011
Duggal N, Paci GM, Narain A, Bournissaint LG, Nazarian A. A computer assessment of the effect of hindfoot alignment on mechanical axis deviation. Comput Methods Programs Biomed. 2014; 113: 126-32. DOI: https://doi.org/10.1016/j.cmpb.2013.09.010
Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RM, Reijman M et al. Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis and rheumatism. 2007; 56: 1204-11. DOI: https://doi.org/10.1002/art.22515
Sharma L, Song J, Dunlop D, Felson D, Lewis CE, Segal N et al. Varus and valgus alignment and incident and progressive knee osteoarthritis. Annals of the rheumatic diseases. 2010; 69: 1940-5. DOI: https://doi.org/10.1136/ard.2010.129742
Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 2001; 286: 188-95. DOI: https://doi.org/10.1001/jama.286.2.188
Sharma L, Chmiel JS, Almagor O, Felson D, Guermazi A, Roemer F et al. The role of varus and valgus alignment in the initial development of knee cartilage damage by MRI: the MOST study. Annals of the rheumatic diseases. 2013; 72: 235-40. DOI: https://doi.org/10.1136/annrheumdis-2011-201070
Zhang Y, Xu L, Nevitt MC, Aliabadi P, Yu W, Qin M et al. Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: The Beijing Osteoarthritis Study. Arthritis & Rheumatism. 2001; 44: 2065-71. DOI: https://doi.org/10.1002/1529-0131(200109)44:9<2065::AID-ART356>3.0.CO;2-Z
Braga L, Renner JB, Schwartz TA, Woodard J, Helmick CG, Hochberg MC et al. Differences in radiographic features of knee osteoarthritis in African-Americans and Caucasians: the Johnston county osteoarthritis project. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 2009; 17: 1554-61. DOI: https://doi.org/10.1016/j.joca.2009.07.011
Wang Y, Zeng Y, Dai K, Zhu Z, Xie L. Normal lower-extremity alignment parameters in healthy Southern Chinese adults as a guide in total knee arthroplasty. J Arthroplasty. 2010; 25: 563-70. DOI: https://doi.org/10.1016/j.arth.2009.03.021
Vaidya SV, Ranawat CS, Aroojis A, Laud NS. Anthropometric measurements to design total knee prostheses for the Indian population. J Arthroplasty. 2000; 15(1): 79-85. DOI: https://doi.org/10.1016/S0883-5403(00)91285-3
Tamari K, Tinley P, Briffa K, Aoyagi K. Ethnic-, gender-, and age-related differences in femorotibial angle, femoral antetorsion, and tibiofibular torsion: cross-sectional study among healthy Japanese and Australian Caucasians. Clin Anat. 2006; 19: 59-67. DOI: https://doi.org/10.1002/ca.20170
Tang W, Zhu Y, Chiu K. Axial Alignment of the Lower Extremity in Chinese Adults. The Journal of bone and joint surgery American volume. 2000; 82: 1603-. DOI: https://doi.org/10.2106/00004623-200011000-00014
Jabalameli M, Moghimi J, Yeganeh A, Nojomi M. Parameters of lower extremities alignment view in Iranian adult population. Acta Med Iran. 2015; 53: 293-6.
Igbigbi PS, Msamati BC, Matanje B. Normal axial angles of the knee joint in adult indigenous Malawians. East Afr Med J. 2003; 80: 415-8.
Kraus VB, Vail TP, Worrell T, McDaniel G. A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. Arthritis & Rheumatism. 2005; 52: 1730-5. DOI: https://doi.org/10.1002/art.21100
Tetsworth K, Paley D. Malalignment and degenerative arthropathy. Orthopedic Clinics of North America. 1994; 25: 367-78. DOI: https://doi.org/10.1016/S0030-5898(20)31921-0
Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of the axial alignment of the lower extremity. The Journal of bone and joint surgery American volume. 1987; 69: 745-9. DOI: https://doi.org/10.2106/00004623-198769050-00016
Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clinical orthopaedics and related research. 1990; 255: 215-27. DOI: https://doi.org/10.1097/00003086-199006000-00029
Matsumoto T, Hashimura M, Takayama K, Ishida K, Kawakami Y, Matsuzaki T et al. A radiographic analysis of alignment of the lower extremities--initiation and progression of varus-type knee osteoarthritis. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 2015; 23: 217-23. DOI: https://doi.org/10.1016/j.joca.2014.11.015
Song MH, Yoo SH, Kang SW, Kim YJ, Park GT, Pyeun YS. Coronal alignment of the lower limb and the incidence of constitutional varus knee in korean females. Knee Surg Relat Res. 2015; 27: 49-55. DOI: https://doi.org/10.5792/ksrr.2015.27.1.49
Igbigbi PS, Msamati BC. Tibiofemoral angle in Malawians. Clinical Anatomy. 2002; 15: 293-6. DOI: https://doi.org/10.1002/ca.10024
Igbigbi P, Kwatampora J. Lower limb angles of East African subjects. West Afr J Anat. 1997;5:9-15.
El Fouhil AF, Khoshhal KI, Al-Nakshabandi NA, Al-Boukai AA, Atteya M. Normal knee angles in the adult Saudi population. Saudi Med J. 2011; 32: 1143-8.
Felson DT, Nevitt MC, Zhang Y, Aliabadi P, Baumer B, Gale D et al. High prevalence of lateral knee osteoarthritis in Beijing Chinese compared with Framingham Caucasian subjects. Arthritis & Rheumatism. 2002; 46: 1217-22. DOI: https://doi.org/10.1002/art.10293
Ilahi OA, Kadakia NR, Huo MH. Inter-and intraobserver variability of radiographic measurements of knee alignment. The American journal of knee surgery. 2000; 14: 238-42.
Khattak MJ, Umer M, Davis ET, Habib M, Ahmed M. Lower-limb alignment and posterior tibial slope in Pakistanis: a radiographic study. Journal of Orthopaedic Surgery. 2010; 18. DOI: https://doi.org/10.1177/230949901001800105
Sabharwal S, Zhao C, Edgar M. Lower limb alignment in children: reference values based on a full-length standing radiograph. Journal of Pediatric Orthopaedics. 2008; 28: 740-6. DOI: https://doi.org/10.1097/BPO.0b013e318186eb79
Derek T, Cooke V, Scudamore RA, Greer W. Axial alignment of the lower limband its association with disorders of the knee. Operative Techniques in Sports Medicine. 2000; 8: 98-107. DOI: https://doi.org/10.1053/otsm.2000.6575
Cooke D, Scudamore A, Li J, Wyss U, Bryant T, Costigan P. Axial lower-limb alignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 1997; 5: 39-47. DOI: https://doi.org/10.1016/S1063-4584(97)80030-1
Maini L, Singh S, Kushwaha NS, Saini A, Rohilla S, Sharma H et al. Radiographic analysis of the axial alignment of the lower extremity in Indian adult males. Journal of Arthroscopy and Joint Surgery. 2015; 2: 128-31. DOI: https://doi.org/10.1016/j.jajs.2015.11.010
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